Assessing the Quality of Clinical Care for Children with Chronic Wet Cough Prior to Respiratory Specialist Consultation

Targets for Improvement

Samantha J. Prime, Julie Marchant, Anne Chang, Nicholas Graves, Helen L. Petsky

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Childhood chronic wet cough is associated with poor health outcomes and increased health service utilisation, however little is known about the quality of primary care currently provided.

Aim: To assess the quality of care provided to children with chronic wet cough prior to referral to a respiratory specialist physician.

Design: Prospective cross sectional study.

Setting: Paediatric respiratory specialist clinics in Brisbane, Australia at (a) Lady Cilento Children’s Hospital, a public tertiary facility and (b) Wesley Hospital, a private facility.

Participants: Children newly referred to a paediatric respiratory specialist between July 2015 and January 2017 with a history of chronic (>4 weeks) wet cough of unknown aetiology.

Main outcome measure’s: The quality of pre-respiratory specialist care was assessed against a 10-item quality indicator tool where a score of 0 reflects poor care and 10 reflects high quality care. The quality indicator tool encompassed both clinical care and referral practices.

Results: The median age of 110 children enrolled was 1.9 years (IQR 1.2, 4.1). Children had a history of coughing illnesses for a median of 53.2 weeks (IQR 24.9, 127.6) prior to receiving a referral to a respiratory specialist. The quality indicator score rated for referrals was median 6 (IQR 5, 8), with 48% referrals from general practitioners scoring between 0-5. Main indicators of poor care were the inappropriate use of antibiotics and delayed specialist referral practices.

Conclusion: Children referred for specialist care were young and had a long history of coughing illness. Based on a quality indicator tool the preliminary care provided prior to referral is poor. Barriers to improving pre-specialist care need to be evaluated and include targeted education, particularly for primary care physicians.
Original languageEnglish
Pages (from-to)96-101
Number of pages6
JournalQuality in Primary Care
Volume26
Issue number4
Publication statusPublished - 31 Jul 2018

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Quality of Health Care
Cough
Referral and Consultation
Public Facilities
Pediatrics
Primary Care Physicians
General Practitioners
Health Services
Primary Health Care
Cross-Sectional Studies
Outcome Assessment (Health Care)
Anti-Bacterial Agents
Physicians
Education
Health

Cite this

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title = "Assessing the Quality of Clinical Care for Children with Chronic Wet Cough Prior to Respiratory Specialist Consultation: Targets for Improvement",
abstract = "Background: Childhood chronic wet cough is associated with poor health outcomes and increased health service utilisation, however little is known about the quality of primary care currently provided.Aim: To assess the quality of care provided to children with chronic wet cough prior to referral to a respiratory specialist physician.Design: Prospective cross sectional study.Setting: Paediatric respiratory specialist clinics in Brisbane, Australia at (a) Lady Cilento Children’s Hospital, a public tertiary facility and (b) Wesley Hospital, a private facility.Participants: Children newly referred to a paediatric respiratory specialist between July 2015 and January 2017 with a history of chronic (>4 weeks) wet cough of unknown aetiology.Main outcome measure’s: The quality of pre-respiratory specialist care was assessed against a 10-item quality indicator tool where a score of 0 reflects poor care and 10 reflects high quality care. The quality indicator tool encompassed both clinical care and referral practices.Results: The median age of 110 children enrolled was 1.9 years (IQR 1.2, 4.1). Children had a history of coughing illnesses for a median of 53.2 weeks (IQR 24.9, 127.6) prior to receiving a referral to a respiratory specialist. The quality indicator score rated for referrals was median 6 (IQR 5, 8), with 48{\%} referrals from general practitioners scoring between 0-5. Main indicators of poor care were the inappropriate use of antibiotics and delayed specialist referral practices.Conclusion: Children referred for specialist care were young and had a long history of coughing illness. Based on a quality indicator tool the preliminary care provided prior to referral is poor. Barriers to improving pre-specialist care need to be evaluated and include targeted education, particularly for primary care physicians.",
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Assessing the Quality of Clinical Care for Children with Chronic Wet Cough Prior to Respiratory Specialist Consultation : Targets for Improvement. / Prime, Samantha J. ; Marchant, Julie; Chang, Anne; Graves, Nicholas; Petsky, Helen L.

In: Quality in Primary Care, Vol. 26, No. 4, 31.07.2018, p. 96-101.

Research output: Contribution to journalArticleResearchpeer-review

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N2 - Background: Childhood chronic wet cough is associated with poor health outcomes and increased health service utilisation, however little is known about the quality of primary care currently provided.Aim: To assess the quality of care provided to children with chronic wet cough prior to referral to a respiratory specialist physician.Design: Prospective cross sectional study.Setting: Paediatric respiratory specialist clinics in Brisbane, Australia at (a) Lady Cilento Children’s Hospital, a public tertiary facility and (b) Wesley Hospital, a private facility.Participants: Children newly referred to a paediatric respiratory specialist between July 2015 and January 2017 with a history of chronic (>4 weeks) wet cough of unknown aetiology.Main outcome measure’s: The quality of pre-respiratory specialist care was assessed against a 10-item quality indicator tool where a score of 0 reflects poor care and 10 reflects high quality care. The quality indicator tool encompassed both clinical care and referral practices.Results: The median age of 110 children enrolled was 1.9 years (IQR 1.2, 4.1). Children had a history of coughing illnesses for a median of 53.2 weeks (IQR 24.9, 127.6) prior to receiving a referral to a respiratory specialist. The quality indicator score rated for referrals was median 6 (IQR 5, 8), with 48% referrals from general practitioners scoring between 0-5. Main indicators of poor care were the inappropriate use of antibiotics and delayed specialist referral practices.Conclusion: Children referred for specialist care were young and had a long history of coughing illness. Based on a quality indicator tool the preliminary care provided prior to referral is poor. Barriers to improving pre-specialist care need to be evaluated and include targeted education, particularly for primary care physicians.

AB - Background: Childhood chronic wet cough is associated with poor health outcomes and increased health service utilisation, however little is known about the quality of primary care currently provided.Aim: To assess the quality of care provided to children with chronic wet cough prior to referral to a respiratory specialist physician.Design: Prospective cross sectional study.Setting: Paediatric respiratory specialist clinics in Brisbane, Australia at (a) Lady Cilento Children’s Hospital, a public tertiary facility and (b) Wesley Hospital, a private facility.Participants: Children newly referred to a paediatric respiratory specialist between July 2015 and January 2017 with a history of chronic (>4 weeks) wet cough of unknown aetiology.Main outcome measure’s: The quality of pre-respiratory specialist care was assessed against a 10-item quality indicator tool where a score of 0 reflects poor care and 10 reflects high quality care. The quality indicator tool encompassed both clinical care and referral practices.Results: The median age of 110 children enrolled was 1.9 years (IQR 1.2, 4.1). Children had a history of coughing illnesses for a median of 53.2 weeks (IQR 24.9, 127.6) prior to receiving a referral to a respiratory specialist. The quality indicator score rated for referrals was median 6 (IQR 5, 8), with 48% referrals from general practitioners scoring between 0-5. Main indicators of poor care were the inappropriate use of antibiotics and delayed specialist referral practices.Conclusion: Children referred for specialist care were young and had a long history of coughing illness. Based on a quality indicator tool the preliminary care provided prior to referral is poor. Barriers to improving pre-specialist care need to be evaluated and include targeted education, particularly for primary care physicians.

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